Recent controversies have focused on whether shaking can injure the infant brain and if a diagnosis of SBS can be confidently made and distinguished from accidents (short falls) and non-traumatic conditions.
This article reviews documented cases, animal, biomechanical, and computer-modelling evidence to support the contention that shaking alone without additional impact results in a rotational brain injury with tearing of cortical emissary veins, parenchymal shearing, cervico-medullary, and hypoxic-ischaemic injury.
While the terminology SBS is best avoided because it implies a mechanism in what is usually an unwitnessed injury, a more secure diagnosis of NAHI can be offered, with varying degrees of certainty, based on clinical, imaging, and ophthalmological findings after excluding conditions simulating these features.
The type of brain injury (inertial, contact, hypoxic-ischaemic) and the context in which it is sustained, may enable an opinion about whether the mechanism is consistent with either a purely rotational or rotational impact-deceleration injury, compressive, penetrative or other combined mechanism.
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